Pharyngo-laryngeal dysfunction and severe COPD.

OBJECTIVES

The course of chronic obstructive pulmonary disease (COPD) features episodic exacerbation, contributing to severity. The present study assessed associations between COPD, dysphonia and dysphagia. Laryngeal aspiration is a risk factor for repeated exacerbation of COPD. Certain risk factors are common to COPD and laryngeal pathology; dyspnea impairs phonation and swallowing.

MATERIAL AND

METHODS

This prospective study included 29 patients with group E COPD outside of exacerbation episodes, and free of neurodegenerative disease and history of head and neck cancer. Phonation and swallowing were assessed concomitantly.

ENDPOINTS: The main study endpoint was the prevalence of phonation and swallowing disorders in severe COPD. The secondary objective was to determine whether vocal disorder is a marker of dysphagia in patients at risk of respiratory infection.

RESULTS

Prevalence of dysphonia and dysphagia was high on objective assessment but underestimated in self-reports. More than 50% of patients showed deficits in at least 1 mechanism of swallowing, and notably delayed triggering of the pharyngeal reflex. Only the s/z ratio was significantly associated with dysphagia.

CONCLUSION

Dysphagia and dysphonia are frequent and underestimated in severe COPD. The present study argues for systematic objective screening of swallowing disorder, even in the absence of complaint or dysphonia.